This lecture includes these contents: Rapid critical appraisal using gate, the gate frame, cross sectional study, clinical use of a diagnostic test, exposure & comparison groups,... Invite you to consult this lecture.
Medical evidence increasing at epidemic rates: we all need EBP skills to keep up-to-date Bastian, Glasziou, Chalmers (2010) 75 Trials and 11Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 7(9) Medical evidence increasing at epidemic rates: we all need EBP skills to keep up-to-date approx 75 new trials published every day Bastian, Glasziou, Chalmers (2010) 75 Trials and 11Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 7(9) Medical evidence increasing at epidemic rates: we all need EBP skills to keep up-to-date MEDLINE 2010 2,000 articles / day approx 75 new trials published every day Bastian, Glasziou, Chalmers (2010) 75 Trials and 11Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 7(9) About 10% of published evidence is worth reading About 1/3 of worthwhile evidence is eventually refuted or attenuated About 1/2 of relevant evidence is not implemented Rapid critical appraisal using GATE Rod Jackson University of Auckland, NZ August 2011 Graphic Appraisal Tool for Epidemiological studies Graphic Approach To Evidence Based Practice Graphic Approach To Epidemiology the GATE frame the shape of every epidemiological study 8 British doctors smoking status measured smokers Lung cancer non-smokers yes no years Longitudinal (cohort) study British doctors smoking status measured smokers Lung function non-smokers normal abnormal Cross-sectional study 10 Questions? 56 The 2nd formula: assessing random error Random error = 95% Confidence Interval(1.96 x Standard Error) 57 4th appraisal task: assess degree of random error in study findings using the 2nd formula Random error = 95% Confidence Interval For the Outcome SSI (low risk group) : EGO = 9.5/1000; (95% CI = 3.2 to 27.5) CGO = 37.9/1000; (95% CI = 21.8 to 65) EGO÷CGO = 0.25 (0.07 to 0.88) EGO-CGO = -28.4 (-52 to -4.8) NNT = -35 (-19 to -211) 58 Excel CATs & paper Gate-lites There is a GATE for every study design www.epiq.co.nz 59 59 Final appraisal task: search for & appraise SRs / meta-analyses using 3rd acronym (FAITH) • Find appropriate studies? • Appraise selected studies? • Include only valid studies? • Total-up (synthesise) appropriately? • Heterogeneity adequately addressed? 60 Systematic Reviews There are Cochrane SRs on this topic and the findings are not consistent 61 Using GATE as a framework for evidence based practice The first steps of EBP Ask a focused question Access (systematically search for) epidemiological evidence to help answer question Appraise evidence found for its validity, effect size, precision (ideally all the relevant evidence) Apply the evidence: a amalgamate the valid evidence with other relevant information (patient/community values, clinical/health issues, & policy context) and make an evidence-based decision; and b act (implement) the decision in practice EBP Step 1: Ask- turn your question into a 5-part PECOT question Participants (the patient problem) Exposure (e.g a therapy) Comparison (there is always an alternative! another therapy or no treatment… Outcome (e.g a disease you want to prevent or manage) Time frame (over which you expect a result) EBP Step 2: Access the evidence – use PECOT to choose search terms Participants (the patient problem) Exposure (e.g a therapy) Comparison (there is always an alternative! another therapy or no treatment… Outcome (e.g a disease you want to prevent or manage) Time frame (over which you expect a result) 65 EBP Step 3: Appraise the evidence ‘using the best evidence from epidemiology to help inform decisions’ more critically (using GATE) more systematically (using FAITH) EBP Step 4: APPLY the evidence by: a AMALGAMATING the relevant information & making an evidence-based decision:’ the X-factor © X-factor: making evidence-based decisions Evidence Clinical / health considerations Patient / community preferences Policy issues Xpertise: ‘putting it all together’ the art of practice ... About 1/2 of relevant evidence is not implemented Rapid critical appraisal using GATE Rod Jackson University of Auckland, NZ August 2011 Graphic Appraisal Tool for Epidemiological studies Graphic... accuracy study 13 GATE: Graphic Appraisal Tool for Epidemiological studies picture, formulas & acronyms 14 14 One picture: the GATE frame every epidemiological study hangs on the GATE frame 15 The... surgical procedures High risk 18 patients need more study 19 1st critical appraisal task: describe study’s design by hanging on GATE frame using PECOT acronym P E C O T 20 Participants Study Setting